SUMMARY Morphological findings in sural nerves were related to nerve conduction in 12 patients with diabetic neuropathy, five with mainly sensory involvement, four with severe, symme,trical sensory-motor polyneuropathy, and three with multiple mononeuropathy. All had loss of large and small myelinated and of unmyelinated fibres, even early in the disease; segmental remyelination was the most prominent myelin alteration in teased fibres, segmental demyelination was found in only a few fibres. Axonal degeneration and Schwann cell damage seem to proceed independently of each other. The relation between recorded conduction velocity and that expected from the diameter of the largest fibres indicated that slowing of 20 to 30% was due to causes other than fibre loss; a grossly diminished conduction velocity was caused mainly by fibre loss. Electrophysiological findings in the sural nerve were largely representative of findings in other nerves, though abnormalities were less marked in the median nerve. In half the endoneurial vessels from diabetic neuropathy the perivascular space was thickened or contained more layers of basal laminae than normal. The same abnormalities were found in one-quarter of the endoneurial vessels from other acquired neuropathies.

This electron microscopic study dcals with thc structure of thc Z disc of frog's skeletal musclc, with special rcgard to thc I filamcnts--whcthcr thcy pass through thc Z disc or terminate at it. In most longitudinal sections thc I filaments tcrminatc as rod-likc projections on cithcr sidc of the Z disc, one I filamcnt on onc side lying between two I filaments on thc opposite side. This indicatcs that the I filamcnts arc not continuous through the Z disc. Thc rod-like projections arc oftcn sccn to consist of filaments (dcnotcd as Z filaments) which mcct at an anglc. In cross-scctions through thc Z region the I filamcnts and Z filamcnts form tctragonal patterns. Thc I filaments are situatcd in the corners of thc squarcs; the obliquc Z filaments form the sides of squares. Thc tctragonal pattern formed by the Z filamcnts is rotated 45 degrees with respcct to thc tctragons formed by thc I filaments on both sides of Z. This structural arrangement is intcrprctcd to indicate that cach I filamcnt on onc sidc of the Z disc faces thc ccntcr of the space bctwccn four I filaments on the oppositc sidc of Z and that the intcrconnection is formed by four Z filaments.

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Passive stretch, isometric contraction, and shortening were studied in electron micrographs of striated, non-glycerinated frog muscle fibers. The artifacts due to the different steps of preparation were evaluated by comparing sarcomere length and fiber diameter before, during, and after fixation and after sectioning. Tcnsion and length were recorded in the resting and contractcd fiber before and during fixation. The I filaments could be traced to entcr the A band between the A filaments on both sides of thc I band, creating a zone of overlap which decreased linearly with stretch and increased with shortening. This is consistent with a sliding filament model. The decrease in the length of the A and I filaments during isometric contraction and the finding that fibers stretched to a sarcomere length of 3.7 # still developed 30 per cent of the maximum tetanic tension could not be explained in terms of the sliding filament model. Shortening of the sarcomeres near the myotendinous junctions which still have overlap could account for only one-sixth of this tension, indicating that even those sarcomeres stretched to such a degree that there is a gap between A and I filaments are activated during isometric contraction (increase in stiffness). Shortening, too, was associated with changes in filament length. The diameter of A filaments remained unaltered with stretch and with isometric contraction. Shortening of 50 per cent was associated with a 13 per cent increase in A filament diameter. The area occupied by the fibrils and by the interfibrillar space increased with shortening, indicating a 20 per cent reduction in the volume of the fibrils when shortening amounted to 40 per cent.

By electron microscopy, the ultrastructure of the M line was investigated in fibers from frog nonglycerinated semitendinosus muscles at body length and at different degrees of shortening and stretch. The M line appeared as a line of high electron opacity in the middle of the A band. Its framework consists of: (i) three (four or five) arrays of transverse M bridges, 200 A apart, connecting each A filament with its six neighbors; (ii) M filaments, parallel to the A filaments, passing through the M line and linking each set of M bridges together. In the shortened fiber the M line remained distinct. At high degrees of stretch, the M line became fainter or indiscernible. This appearance reflects a misalignment of the M components caused by a staggering of the A filaments. The M line reappeared after release of fibers stretched 70-80% above equilibrium length. On the basis of the structural analysis, the possible function of the M line is compared with that of the Z line, and a model is suggested for the M line.

Electron micrographs of 45 sural nerves from patients with acquired (22) or heredodegenerative neuropathy (23) were analysed with respect to the number of unmyelinated nerve fibres, 37 nerves with respect to the number of Schwann cell sub-units and of structures connected with Schwann cells. Findings were compared with those in 6 nerves from control subjects and referred to the total number rather than to the number per mm2 to eliminate error due to increase in the transverse endoneurial area, present in more than half the diseased nerves. Ninety-one per cent of the diseased nerves showed one or several abnormalities in unmyelinated fibres of their Schwann cells. The best indicator of fibre loss was an increase in the number of Schwann cell sub-units devoid of axons, found in more than half the nerves. This was the only abnormality related with decrease in number of myelinated fibres. The increase in number of empty Schwann cell sub-units was due both to loss of unmyelinated nerve fibres and to proliferation of Schwann cells. Proliferation was indicated by the higher incidence of Schwann cell nuclei in cross-sections of diseased nerves than in controls. The earliest sign of involvement was an increase in number of profiles and of small isolated Schwann cell projections, observed in 33 of 37 diseased nerves, as the only abnormality in 7 nerves. The number of unmyelinated nerve fibres by itself was of little value to indicate loss of fibres, since regeneration often replaced or more than replaced degenerated fibres. Regeneration was indicated by an increase in number or incidence of small unmyelinated fibres, present in nearly half of 45 diseased nerves; and by an increased in the total number, present in a third of the nerves. An increase in the number of collagen pockets and of fibres undergoing degeneration (loss of organelles) and a decrease in the number of unmyelinated fibres per Schwann cell sub-units was present in only a quarter to a third of diseased nerves and was not related to other criteria of loss of fibres or of regneration.

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Glycerol-extracted rabbit psoas muscle fibers were examined by electron microscopy both before and after ATP-induced isotonic shortening. Ultrastructural changes were correlated with the initial sarcomere length and the degree of shortening. The ultrastructurai appearance of the resting fiber at rest length was identical with that described by H. E. Huxley and Hanson. At sarcomere lengths greater than 3.7 to 3.8 #, the A and I filaments were detached and separated by a gap. The presence of "gap" filaments was confirmed, and evidence is presented which indicates that these filaments form connections between the ends of the A and I filaments. Shortening from initial sarcomere lengths at which the filaments overlapped took place through sliding of the filaments. If shortening was initiated from sarcomere lengths at which there was a gap, a narrowing of the I band was brought about by a curling of the I filaments at the boundary between the A and I bands. No evidence could be found that the I filaments moved into the A band.